From the FDA Drug Label
The usual initial antihypertensive oral dose of Amlodipine besylate tablets is 5 mg once daily, and the maximum dose is 10 mg once daily. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps.
The best approach is to increase the dose of amlodipine if the patient's blood pressure is not well-controlled on 5 mg, as the maximum dose is 10 mg once daily.
- The dosage should be adjusted according to blood pressure goals.
- It is recommended to wait 7 to 14 days between titration steps.
- If the patient's blood pressure is still not well-controlled after increasing the dose to 10 mg, another antihypertensive agent may be considered. 1
From the Research
When managing uncontrolled hypertension in a patient taking amlodipine 5 mg, it's generally better to add a second antihypertensive agent from a different class rather than increasing the amlodipine dose to 10 mg. While increasing amlodipine to 10 mg can provide some additional blood pressure reduction, this approach often yields diminishing returns while potentially increasing side effects like peripheral edema. Adding a complementary medication—such as an ACE inhibitor (like lisinopril 10-20 mg daily), an ARB (such as losartan 50 mg daily), or a thiazide diuretic (like hydrochlorothiazide 12.5-25 mg daily)—typically provides more effective blood pressure control through different physiological mechanisms. This combination approach targets multiple pathways in blood pressure regulation, often resulting in synergistic effects. For example, while amlodipine blocks calcium channels in vascular smooth muscle to cause vasodilation, an ACE inhibitor blocks the renin-angiotensin-aldosterone system 2. Before adding a second agent, ensure the patient is taking amlodipine regularly, following sodium restriction guidelines, and implementing lifestyle modifications such as regular exercise and weight management if needed. It is also crucial to monitor the patient's blood pressure regularly, ideally within 4-6 weeks after initiating or adjusting therapy, to assess the effectiveness of the treatment plan and make any necessary adjustments 3, 4. Given the potential for increased side effects with higher doses of amlodipine, such as peripheral edema, careful consideration should be given to the risk-benefit ratio of dose escalation versus adding a new agent 5, 6. Ultimately, the decision to increase the dose of amlodipine or add another antihypertensive agent should be based on the individual patient's response to treatment, their overall health status, and the presence of any comorbid conditions that may influence the choice of therapy.